ArticleTherapeutic advances in gastroenterology2026
Association between a 24-h increase in blood urea nitrogen and clinical outcomes in acute non-variceal upper gastrointestinal bleeding: a dual-center retrospective cohort study.
Article in Therapeutic advances in gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and aim: Blood urea nitrogen (BUN) is incorporated into admission-based risk scores for acute non-variceal upper gastrointestinal bleeding (NVUGIB); however, the clinical relevance of early in-hospital BUN kinetics remains unclear. Objectives: To evaluate whether a 24-h increase in BUN is independently associated with adverse clinical outcomes in patients with acute NVUGIB. Design: Dual-center retrospective cohort study. Methods: We conducted a dual-center retrospective cohort study of adult patients with endoscopically confirmed NVUGIB admitted between 2018 and 2023. The exposure was defined as any absolute increase in BUN within 18-30 h after the baseline measurement at presentation. The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, in-hospital rebleeding, red blood cell transfusion, length of hospital stay, and need for radiologic or surgical intervention. Multivariable regression was performed in a propensity score-matched cohort with confirmatory analyses in the original cohort. Results: Among 611 patients, 218 (35.7%) demonstrated a 24-h increase in BUN. Propensity score matching yielded 400 patients (200 per group). In the matched cohort, a 24-h BUN increase was independently associated with higher 30-day mortality (adjusted odds ratio (aOR) 3.307; 95% confidence interval (CI) 1.604-6.819) and in-hospital mortality (aOR 2.732; 95% CI 1.208-6.178). No independent associations were observed with rebleeding, transfusion requirements, or radiologic/surgical intervention. Conclusion: An increase in BUN within the first 24 h of hospitalization is independently associated with higher short-term mortality in acute NVUGIB. Early BUN kinetics may serve as a complementary risk marker, but prospective validation and formal predictive-performance testing are needed before clinical integration.
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